Athlete’s foot is a skin fungal infection. It can lead to intense itching, cracked, blistered or peeling areas of skin, redness and scaling. It can occur on moist, waterlogged skin usually between the fourth and fifth toes initially, or on dry, flaky skin around the heels or elsewhere on the foot. Large painful fissures can also develop and the condition can also spread along all five toes and sometimes to the soles of the feet if left untreated.
Once your feet have been contaminated, the warm, dark and sweaty environment of feet cramped in shoes or trainers provides the ideal breeding ground for the fungus. However, athlete’s foot also occurs in dry, flaky areas. It’s quite common in summer with sandal wearers. The sun makes your skin dry out so it loses its natural protective oils. This combined with the constant trauma from sandals makes them more prone to infection.
For athlete’s foot where the skin conditions are dry: if the condition occurs on a dry area such as your heel, you need to restore moisture by rubbing in an anti-fungal cream or spray, sometimes combined with a steroid cream (all from your pharmacist). You must remember to wash your hands thoroughly afterwards, or use disposable gloves so you don’t get the fungus on your hands at all. For athlete’s foot where the skin conditions are moist: this condition requires an altogether different type of treatment to that above. Wash your feet in as cold water as you can bear (as hot water only makes your feet fungus-friendly) then dry them thoroughly after washing, preferably with a separate towel or even kitchen roll. It is important to dab your feet dry rather than rub them, as rubbing tends to take away any healing skin. Although the skin may appear flaky and dry, never use moisturiser between your toes, also avoid powders as they can cake up and irritate skin. A spirit-based preparation can help such as surgical spirit (it’s cooling, soothing and antiseptic). This may sting a little but will evaporate the moisture and allow the skin to heal.
Callus (or callosity) is an extended area of thickened, hard skin on the soles of the feet. It is usually symptomatic of an underlying problem such as a bony deformity, a particular style of walking or inappropriate footwear. Some people have a natural tendency to form callus because of their skin type. Elderly people have less fatty tissue in their skin and this can lead to callus forming on the ball of the foot. Your podiatrist will also be able to remove hard skin, relieve pain and redistribute pressure with soft padding, strapping or corrective appliances which fit easily into your shoes. The skin should then return to its normal state.
Corns are caused by pressure or friction over bony areas, such as a joint, and they have a central core which may cause pain if it presses on a nerve. There are five different types of corns, the most common of which are ‘hard’ and ‘soft’ corns:
Hard corns – these are the most common and appear as a small area of concentrated hard skin up to the size of a small pea usually within a wider area of thickened skin or callus. This may be a symptom of the feet or toes not functioning properly.
Soft corns – these develop in a similar way to hard corns but they are whitish and rubbery in texture and appear between toes where the skin is moist from sweat or from inadequate drying.
Seed corns – these are tiny corns that tend to occur either singly or in clusters on the bottom of the foot and are usually painless.
Vascular corns – these can be very painful and can bleed profusely if cut.
Fibrous corns – these arise when corns have been present for a long time and are more firmly attached to the deeper tissues than any other type of corn. They may also be painful.
Your podiatrist will be able to remove corns painlessly, apply padding or insoles to relieve pressure or fit corrective appliances for long-term relief.
An ingrowing toenail is one that pierces the flesh of the toe. It can feel as if you have a splinter, be extremely painful and inflamed or infected. In more severe cases, it can cause pus and bleeding. Ingrowing toenails most commonly affect the big toenail, but can affect the other toes too. Whereas a nail that is curling (involuted or convoluted) into the flesh, but isn’t actually piercing the skin, isn't an ingrowing toenail but can feel very painful and also appear red and inflamed as well.
Before you are seen by a podiatrist, you can relieve the discomfort by bathing your foot in a salty footbath which helps to prevent infection and reduces inflammation. Then apply a clean sterile dressing, especially if you have a discharge and rest your foot as much as possible.
How a podiatrist will treat you will depend largely on the severity of your condition:
For the most basic painful and irritable ingrowing toenail, the offending spike of nail will be removed and covered with an antiseptic dressing.
For toes too painful to touch, a local anaesthetic will be injected before removing the offending portion of nail.
For involuted nails, part of the nail that is curling into the flesh is removed and then the edges of the nail are filed to a smooth surface.
For any bleeding or discharge from an infection, or even excessive healing flesh (hypergranulation tissue) around the nail, antibiotics will be suggested from your GP to beat the infection as well as having the offending spike removed.
For those particularly prone to ingrowing toenails from underlying problems nail surgery (partial nail avulsion - PNA) may be recommended. This procedure is done under a local anaesthetic where 8-10% of the nail is removed (including the root) so that the nail permanently becomes slightly narrower. The chemical phenol cauterises the nail and prevents it regrowing in the corners. This is over 95% successful. You will, however, have to go back to your podiatrist for a number of re-dressings. After surgery, the overall appearance of the nail looks normal – to the extent that some people even forget which nail they’ve had done!
Verrucae are plantar warts that commonly occur on the soles of the feet or around the toe area. They are caused by the Human Papilloma Virus (HPV) which is highly contagious through direct person to person contact. There are various forms of HPV which all relate to various parts of the human body.
The most common appearance is that of a small cauliflower type growth on the soles of your feet with tiny black dots. If when you pinch the area (like when you squeeze a spot) it is painful, you are likely to have a verruca. They can grow to half an inch in diameter and may spread into a cluster of small warts. If you are unsure, seek advice from your local pharmacist or visit a podiatrist. In the first instance, avoid touching or scratching it as it may spread into a cluster of warts. Instead, cover it up with a plaster and this may cure it. In many cases, evidence suggests that verrucae will disappear of their own accord within six months for children but longer for adults (up to two years). This is because the body’s immune system recognises the presence of the virus and fights the infection naturally but it can take many months for this to happen. If it is painless, no treatment may be required as some treatments can be painful especially for children and can cause side-effects.
For painful and/or unsightly verrucae or ones which are spreading, you can self-treat using ointments and gels from your local pharmacist following the instructions carefully. Evidence suggests the most effective ones contain salicylic acid which when applied to the wart, helps to disintegrate the viral cells. Sometimes, merely by rubbing away the dry skin over a verrucae and applying a plaster helps to stimulate the body’s immune system to fight the infection. However, if your verruca becomes unusually painful or the surrounding skin area goes red, stop treatment immediately and see a podiatrist. This is because if the healthy tissue around a verruca is damaged, you could hamper further treatment.
Treatments provided by a podiatrist involve an assessment of your general well-being and foot health before deciding on a treatment plan. These may include:
Acid based treatments which are stronger than regular ‘over the counter’ (OTC) treatments from your local pharmacy
Cryotherapy which involves freezing the verruca.
Electrosurgery which requires a local anaesthetic to be given
Excisional surgery which is similar to the above
Laser surgery, particularly for larger areas of verrucae